의식 없는 말기환자 가족의 연명치료 중단 결정 경험

김명희,강은희,김미영,Kim, Myung-Hee,Kang, Eun-Hee,Kim, Mi-Young 한국호스피스완화의료학회 2012 한국호스피스.완화의료학회지 Vol.15 No.3

Purpose: The purpose of this study is to understand family members' experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. Methods: Data were collected by performing an in-depth interview with eight terminally-ill patients' family members who decided to withdraw life-sustaining treatments. Colaizzi's phenomenological method was used for data analysis. Results: Questions were classified into 12 groups and finally into five categories. The five categories were about family members' frustration with patient's condition, emotional preparation for the patient's death upon medical professionals' recommendation, patient's wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. Conclusion: Using the five categories, hospice and palliative professionals could better understand family members' decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention. 목적: 본 연구의 목적은 의식 없는 말기환자 가족의 연명치료 중단 결정 경험을 이해하기 위함이다. 방법: 자료는 의 없는 말기환자의 연명치료 중단 결정을 한 8명의 가족으로부터 심층면담을 통해 수집하였다. Colaizzi의 현상학적 분석 방법이 자료 분석을 위해 사용되었다. 결과: 주제는 12개의 주제모음으로 분류되었고, 12개의 주제모음은 마침내 5개의 범주로 통합되었다. 5개의 범주는 환자상태로 인한 절망감, 의료진의 권고에 마음을 비움, 환자의 바램, 돌봄으로 인한 가족의 소진, 연명치료와 관련된 과거의 경험이었다. 결론: 다섯 개의 범주를 통하여 의식 없는 말기환자 가족의 연명치료 중단 결정 과정에서 발생할 수 있는 현상들을 이해함으로써 적절한 상담과 간호를 제공하여 보다 바람직한 호스피스 완화의료 중재가 필요하다고 본다.

림프절 전이가 동반된 진행성 위암 환자에서 수술 전 항암요법으로 시행한 FOLFOX 치료로 완전 관해를 보인 1례

김명희,정현용,문희석,성재규,강선형,김주석,Myung Hee Kim,Hyun Yong Jeong,Hee Seok Moon,Jae Kyu Sung,Sun Hyun Kang,Ju Seok Kim 대한소화기암연구학회 2018 Journal of digestive cancer reports Vol.6 No.1

국소적인 진행성 위암의 근치적인 치료는 수술이 첫 번째 방법이다. 하지만 위암을 진단받은 환자 중에서 약 30% 만이 수술이 가능한 진행성 위암으로 진단을 받으며 그 중 약 40-60% 만이 R0 절제술이 가능하다. 저자들은 위 주위 림프절과 복강 림프절, 장막을 침범한 진행성 위암을 진단받은 환자를 3주간의 수술 전 항암화학요법으로 치료하였고, 근치적인 목적으로 위 절제술을 시행하였다. 조직병리검사에서 완전히 괴사된 종양 조직을 관찰할 수 있었고, 수술 후 현재까지 3차례의 추가적인 전신 항암화학요법을 시행하고 있으며, 추적 복부 전산화단층촬영에서 재발을 시사하는 소견을 보이지 않았다.

허균과 매창의 시조

김명희(Kim Myung-Hee) 한국시조학회 2005 시조학논총 Vol.22 No.-

허균과 매창은 사대부와 기녀의 관계로 알게 된 사이다. 그러나, 허균은 매창을 여성 문학인으로 재능을 인정하고 평생 詩友로 존경하며 사랑한 사이였다. 허균은 천재 시인, 혁명가, 이상향을 꿈꾸는 평등주의자여서 여성과 서얼을 인간으로 대접하려는 따뜻한 성품의 소유자였다. 그러한 허균이 매창을 중국에 기녀시인 설도에 비견하고 매창을 조선의 최고 기녀시인으로 손꼽는 데는 매창 시의 한 특성이 있다고 본다. 그녀의 시조는 상실감에 가득한 비애 가운데서도 임과의 재회를 꿈꾸는 소망의식이 가득한 시 의식을 지니고 있다고 본다. 또한, 그녀는 사대부와의 관계에서 나름대로 등거리 사랑을 추구하였고 그에 성공하였기 때문에 성적 욕망의 대상인 기녀 신분이면서도 성이 뒤로 앉은 貞操 어린 여성으로 자리 잡아 사대부들의 존경과 시선을 한 몸에 받은 시인이었다. 허균의 폄하 발언으로 얼룩진 평가를 재평가하고, 매창의 시가 비애 의식에 머물러 있지 않고 소망의식으로 발돋움하였다는 것을 밝히고 있다. Woman is individual than social. passive than active and defensive than offensive. In addition. they taught that these characters are femine in the middle ages and the feudal ages. The closed and limited society was common to women in the feudal society. But there were many classes in women society from the humble maids to the queen in Chosun Dynasty. And Kisaeng(a singing and dancing girl) was free in comparison with the noble women. But Kisaeng were also limited as woman. They could write literary works according to the playing with poems and something like that with the men of intellectual class. But this also gave them sorrows. In the feudal Chodun Dynasty. men recognized the noble women specially and this is the special quality of Chosun. The Confucianism which was the existense thought of Chosun, discriminated between men and women. But women studied secretly and wrote poems pouring their thoughts and emotions. Maechang wrote many Shijo (Korean verse) with the delicacy description and the real expression. The reason Chosun woman Maechang could wrote Shijo which is free from the feudal limitations is that she was Kisaeng, She had a love as a Kisaeng who had to play with the intellectual men. But she loved Yu hee-kyoung. So she preserved chastity for him and waited only him. This is the love of both body and soul. And love with Hu kyoon friendship which is far from love. The limited love because of the spatial parting and the discrepancy of the social position is the most sorrowful. 10 years love with the intellectual men such as Hu kyoon is a friendship with poems. It was not love, so they had to temperate, So they love each other as a literary friend. We can see the feminist Hu kyoon, and see Hu kyoon who loved the literature and assert the renovation. Maechang was free from the chastity but she preserved it because of her proud. She dreamed the fairyland as Hunansulhun. Because she couldn't realize love. She ended her literature and Kisaeng life at 38 years old. There are literature of nansulhun as a noble woman and of maschang as a Kisaeng in Chosun Dynasty.

담수어중의 (淡水魚中) 총수은함량에 (總水銀含量) 관한 연구 (1) - 수종의 (數種) 금강하류 (錦江下流) 담수어에 (淡水魚) 대하여 -

김명희,박성배 ( Myung Hee Kim,Sung Bae Park ) 한국하천호수학회 1981 생태와 환경 Vol.14 No.3·4

This study was performed to investigate the present contamination level of total mercury in freshwater fishes. The samples were collected at kangkyung area located in Kum river from May to July in 1890. Experimental subjects were fifty seven case from seven kinds of fishes, and dissected into four parts; muscle, bone, liver and gill. Contents of total mercury in the parts were determined by mercury analyzer. The results were as follows: 1. In the muscle tissue, mean Contents of total mercury was 0.351ppm; the highest was 0.522±0.038ppm in shake head; the lowest was 0.207±0.022ppm in eel. 2. The order of the mean value of total mercury contents in four parts were muscle>liver>bone>gill, respectively. 3. Food chain was a factor which affected the concentration of total mercury in the fishes. In the most case, carnivorous fish had higher level of total mercury than omnivorous. 4. In the relationship between size and mercury concentration, mercury level tended to increase with size, age.

초등학교 저학년과 고학년 학생의 식습관 및 기호도 조사 - 대전지역을 중심으로 -

김명희,윤선영,김미원,Kim, Myung Hee,Yoon, Sun Young,Kim, Mi Won 한국식품영양학회 2013 韓國食品營養學會誌 Vol.26 No.4

The purpose of this study is to analyze the differences of food habits and food preferences between lower and higher grade students through the survey of elementary school students in Daejeon four elementary schools located in Jung-Gu and Seo-Gu in Daejeon are selected for this survey randomly and the completion of the questionnaires are according to grade. 1. Practical Analysis of Food Habits: For regular meals, the highest number of subjects skipped breakfast. It is being found that the girl students (81.61%) consumed more cooked rice than the boys (78.85%) and more boys (13.10%) ate bread or milk more than the girls (9.20%). The most important thing for the lower grades students (34.20%) when consuming is the nutritious foods, while the higher grades students (49.67%) consumed the set meals. During consumption, the highest number of the subjects watched TV or read books from time to time. More higher grades students (38.98%) preferred spicy and salty foods than the lower grades (22.09%). 2. Food Preferences: Between rice and noodles, most subjects preferred cooked rice (81.38%), Jajangmyeon (80.80%), Ramyeon (79.43%), and disliked bean-mixed rice (28.39%). For soups, Most students enjoy the Deokkguk. Majority of the subjects prefer meat and fried or steamed foods, and also grilled and pan-fried dishes. For the pan-roasted and fried dishes, most subjects did not enjoy the rhizome fry and sweet-pumpkin fry methods, and for vegetables, they did not like wild vegetable and seasoned cucumber (40.57%) The higher grades students enjoy the vegetables and salads more than the lower grades students. For Kimchi varieties, it is found that subjects like the cabbage Kimchi (69.66%) the most. There is little difference in food preference between the lower and higher grade students, but the rankings of food preferences are different according to various grades.

Bacillus brevis CD162 Cyclodextrin Glycosyltransferase의 정제 및 특성

김명희,손천배,임영희,오태광 ( Myung Hee Kim,Cheon Bae Sohn,Young Hee Lim,Tae Kwang Oh ) 한국응용생명화학회 1997 Applied Biological Chemistry (Appl Biol Chem) Vol.40 No.6

γ-Cyclodextrin Glycosyltransferase 생산균주의 분리 , 동정 및 효소 생산조건

김명희,손천배,임영희,배경숙,오태광 ( Myung Hee Kim,Cheon Bae Sohn,Young Hee Lim,Kyung Sook Bae,Tae Kwang Oh ) 한국응용생명화학회 1997 Applied Biological Chemistry (Appl Biol Chem) Vol.40 No.6

A cyclodextrin glycosyltransferase-producing bacterium was newly isolated from soil using alkaline pH medium containing 1% Na₂CO₃. The isolated strain was identified as Bacillus brevis by morphological and biochemical characteristics, and fatty acid composition and designated Bacillus brevis CD162. The strain showed the best enzyme production of 0.9 unit/㎖ after 96 hrs of culture at 30℃ in a medium of 2.0% soluble starch, 0.75% yeast extract, 0.5% bacto peptone, 0.2% K₂HPO₄ 0.05% MgSO₄·7H₂O, and 1.5% Na₂CO₃ at initial pH 10.2.

외생균근 (外生菌根) 및 토양조건이 리기다소나무 균목생장에 (菌木生長) 미치는 영향

김명희,이수욱 ( Myung Hee Kim,Soo Wook Lee ) 한국산림과학회 1985 한국산림과학회지 Vol.70 No.1

The experiment was conducted to test the effects of ectomycorrhizal inoculation and soil moisture regime on growth and nutrient uptake of Pinus rigida seedlings. Two-year-old seedlings inoculated with either Pisolithus tinctorius or Thelephora terrestris were used for this experiment. There were two moisture treatments and four phosphate treatment levels with three replications. Height and root collar diameter growth and dry weight increase were measured and nitrogen, phosphorous, and potassium in the tissue were analyzed three months after the initiation of phosphate and moisture regime treatment. Results are as follows; 1) Height growth of seedlings was not affected in all treatments. (mycorrhizae, fertility, moisture). 2) High moisture regime increased root collar diameter growth 2.7 .times as large as low moisture regime. 3) In low moisture regime, net production increased 26% in seedlings inoculated with Pisolithus tinctorius and increased 72% control seedlings. 4) In high moisture regime, net production of inoculated seedlings with Pisolithus tinctorius increased four times as much as that of control seedlings but increased P₂O_5 in fertility level did not affect net production. 5) In uptake of nitrogen, phosphate, and potassium, Pisolithus tinctorius - inoculated seedlings increased uptake by 1.9, 1.8, and 1.5 times, respectively, as much as control seedlings. 6) Increase in P₂O_5 fertility level enhanced the uptake of P₂O_5 in Pisolithus tinctorius - inoculated seedlings, but not affected the uptake of P₂O_5 in control seedlings. 7) Increase in P₂O_5 fertility levels enhanced the uptake of K₂O in Pisolirhus rinctorius - inoculated seedlings.

구강내과영역에서 측두하악장애 환자의 Spiral Taping 치료

김명희,이정훈,Kim, Myung-Hee,Lee, Jeong-Hun 대한안면통증구강내과학회 2011 Journal of Oral Medicine and Pain Vol.36 No.1

최근 저작, 개구장애, 두경부의 동통 및 관절 잡음을 나타내는 턱관절 기능장애 환자가 점차 증가 추세에 있다. 그러나 대부분의 치료가 기간대비효과 및 지속성이 떨어지는 단점을 가지고 있다. 또한, 고비용과 장기간의 치료와 구강 장착물의 이물감으로 인한 불편감 등으로 좋은 치료법으로 선호되기 힘든 상황이다. 테이핑 치료방법은 시행하기가 비교적 간단하고 부작용이 없어 안정성이 높으면서도 치료효과가 탁월하다. 본 연구에서는 최근 비교적 쉽게 환자를 치료하고, 치료에 따른 부작용 없는 테이핑 요법 중 Spiral Taping법을 이용하여 턱관절의 통증과 관절가동범위의 제한을 일으키는 근육에 비신축성 테이프를 적용하여 측두하악장애의 효율적인 치료의 기본적인 방향을 설정하여 구체적인 치료방법과 치료절차에 대해 알아보고자 하였다.

운동강도와 지속시간에 따른 트레드밀 운동이 비만 쥐의 심장근 내 항산화에 미치는 영향

김명희,김용억,윤창륙,유지원,안종모,Kim, Myung-Hee,Kim, Young-Eok,Yoon, Chang-Lyuk,Ryu, Ji-Won,Ahn, Jong-Mo 대한안면통증구강내과학회 2013 Journal of Oral Medicine and Pain Vol.38 No.1

트레드밀 운동이 비만 쥐의 심장근 내 항산화에 어떠한 영향을 주는지 알아보고자 흰쥐에 6주 동안 고지방 식이로 비만을 유발시킨 뒤 운동강도와 적용시간을 달리하여 트레드밀을 3주 동안 적용하였으며, 체중변화, 혈중지질성분, 조직학적 변화, 심장근 내 항산화 효소와 MCP-1(monocyte chemoattractant protein-1) 등의 변화를 연구하였다. 4주령 Sprague Dawley계 수컷 흰쥐 32마리를 사용하여 각각 일반사료를 섭취한 정상군 (normal), 비만 대조군 (control), 비만 쥐에게 고강도 분할운동을 적용한 실험군 I(Experimental I), 비만 쥐에게 중강도 지구력 운동을 적용한 실험군 II (Experimental II)로 나누었다. 실험 결과 첫째, 체중변화는 고강도 분할 운동을 적용한 실험군 I과 중강도 지구력 운동을 적용한 실험군 II는 대조군에 비해 유의한 감소가 있었다 (p<0.001). 특히, 운동을 적용한 1주에서 3주까지 유의한 차이가 있었다. 둘째, 혈중지질성분 수치는 고강도 분할 운동을 적용한 실험군 I과 중강도 지구력 운동을 적용한 실험군 II는 대조군에 비해 총콜레스테롤, 중성지방, 저밀도 지단백질의 유의한 감소, 고밀도 지단백질에서는 유의한 증가가 있었다 (p<0.001). 셋째, 심장근의 조직학적 소견은 심장근에서 아교질 형성과 평활근 섬유의 정렬 상태와 밀집도, 심장근 세포크기가 중강도 지구력 운동 적용한 실험군 II에서 정상군과 비슷한 형태인 근육들이 잘 밀집해 있는 것을 볼 수 있었다. 또한, 섬유아세포, 염증세포들의 침윤 등이 고지방 식이 유발 쥐인 대조군과 고강도 분할 운동을 적용한 실험군 I에서 가장 심하였으며, 중강도 지구력 운동을 적용한 실험군 II는 대조군에 비해 섬유아세포, 염증세포들의 침윤 등이 현저히 감소하였다. 넷째, 심장근의 항산화 효소 SOD(superoxide dismutase), CAT(catalase), GPx(glutathione peroxidase) 수치는 중강도 지구력 운동을 적용한 실험군 II와 고강도 분할 운동을 적용한 실험군 I에서 모두 유의한 증가가 있었다 (p<0.001). 다섯째, 심장근의 항산화 단백질 MCP-1 발현 수치는 고강도 분할 운동을 적용한 실험군 I과 중강도 지구력 운동을 적용한 실험군 II 모두에서 감소가 있었으며 (p<0.01), 특히, 중강도 지구력 운동을 적용한 실험군 II에서는 유의한 감소가 있었다 (p<0.001). 따라서, 중강도 지구력 운동은 고지방 식이로 유발된 비만 쥐의 심장근 내 항산화에 영향을 주어 비만 개선과 산화적 스트레스에 의한 심장근육 손상 감소 등에 효과적인 것으로 나타났다. The aims of this study was to observed an effect of antioxidative in cardiac muscle of high fat diet induced obesity rat by treadmill exercise with intensity and time. Thirty-two Sprauge-Dawley rats which were divided into four group. Normal, Control(high fat diet induced obesity rat), Experimental I(high intensity intermittent exercise in high fat diet induced obesity rat), Experimental II(moderate intensity endurance exercise in high fat diet induced obesity rat). The results of this study were as follows: 1. In change of body weight, the outcome of each group significantly difference compared with control. Also, 1 to 3 weeks significantly different compared with pre valu experimental I and II(p<0.001). 2. In change of lipid profile, the outcome of each group significantly difference compared with control(p<0.001). Difference between experimental I and II is not significantly. 3. In change of antioxidative enzymes(SOD, CAT, GPx) in myocardium, there are significant difference between control and experimental II, and also between control and experimental I(p<0.001). 4. In change of antioxidative protein MCR-1, the outcome of each group significantly difference compared with control(p<0.01). Experimental II was most significantly difference than the other group(p<0.001). The above results suggest that treadmill exercise effectively reduced in fat. It would be considered that moderate intensity endurance exercise has an effects on improved antioxidative enzyme in cardiac muscle of high fat diet induced obesity rat.